Provider Demographics
NPI:1205927472
Name:MYERS, ANGELA D (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:D
Last Name:MYERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 OFFICE PLZ
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2807
Mailing Address - Country:US
Mailing Address - Phone:850-309-1665
Mailing Address - Fax:850-309-0150
Practice Address - Street 1:225 OFFICE PLZ
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2807
Practice Address - Country:US
Practice Address - Phone:850-309-1665
Practice Address - Fax:850-309-0150
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL858902363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303950100Medicaid
FLP05924Medicare UPIN
FLP05924Medicare UPIN